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51
METHUSELAH
Comparative effcacy and tolerability
of antidepressants for major
depressive disorder in children and
adolescents
Lancet 2016; 388: 881--90
Major depressive disorder is common
in young people with an estimated point
prevalence of 2.8% in school-age children
(aged 6–12 years) and 5.6% in adolescents
(aged 13–18 years). Psychological
treatments are still considered the frst-line
treatments in many clinical guidelines but
antidepressants are widely used.
In this network meta-analysis the
researchers have investigated the effcacy
and tolerability of 14 antidepressant drugs.
They found 34 eligible trials including 5,260
participants, in which the antidepressant
used was compared with a placebo.
They reached the conclusion that when
considering the risk-beneft profle of
antidepressants in the acute treatment
of major depressive disorder, these drugs
do not seem to offer a clear advantage for
children and adolescents. Fluoxetine is
probably the best option to consider when a
pharmacological treatment is indicated.
What is the effect of stopping elastic
compression stocking (ECS) therapy 12 months
after a diagnosis of proximal deep venous
thrombosis versus continuing ECS for 24
months on the occurrence of post-thrombotic
syndrome and disease specifc quality of life?
That is the question asked in this multicentre
trial performed in the Netherlands. Five
hundred and eighteen patients were
randomised to either 12 or 24 months of
treatment. The proportion of patients that
developed the post-thrombotic syndrome was
19.9% in the group that stopped ECS at 12
months and 13% in those who continued ECS
for 24 months. The authors estimate that 14
patients would have to continue ECS to prevent
one case of post-thrombotic syndrome.
They believe that ECS therapy should ideally
be continued for 24 months in ECS compliant
patients after deep venous thrombosis.
Stockings to prevent post-thrombotic
syndrome
BMJ 2016; 353: i2691
A trial involving adults 50 years of age or
older showed that the herpes zoster subunit
vaccine (HZ/su) containing recombinant
varicella-zoster virus glycoprotein E and the
AS01B adjuvant system was associated with
a risk of herpes zoster that was 97.2% lower
than that associated with placebo.
This report concerns a similar trial
conducted in subjects 70 years of age or older.
Thirteen thousand nine hundred participants
(mean age 75.6 years) were randomised to
receive either HZ/su or placebo. At 3.7 years
follow-up the incidence of herpes zoster was
89.8% lower in those vaccinated with HZ/
su compared with the placebo group. Serious
adverse effects, potential immune-mediated
diseases and deaths occurred with similar
frequencies in the two groups.
The researchers conclude that the use of
HZ/su is effcacious and safe when used in
adults 70 years of age or older.
Effcacy of the herpes zoster subunit
vaccine in adults 70 years of age or
older
N Engl J Med 2016; 375: 1019--32
Methuselah